Urethral Stricture Disease

Objective: to identify areas in urethral stricture disease where there is sufficient evidence to direct decision making, Method: A literature search involving PubMed and the Cochrane Library was performed spanning the period between 1990 and 2008 to evaluate the evidence for certain controversial topics in urethral stricture disease management, Results and Conclusions: There is a paucity of randomized controlled trials. Weak evidence supports the use of primary endoscopic realignment of posterior urethral disruption compared to suprapubic cystostomy and delayed repair. Early endoscopic realignment offers a minimally invasive approach, can be performed in a retrograde, antegrade or in a combined fashion. While it appears to be associated with decreased stricture rate, selection biases weaken the results.. Ventral vs. dorsal placement of the buccal mucosal graft does not appear to influence the success rate of single stage urethroplasty for bulbar urethral strictures. The best technique to use is one with which the surgeon is most experienced. The evidence is good favoring superior outcomes with primary anastomotic urethroplasty for treatment of bulbar urethral strictures 1-2 cm in size. Success rates for primary anastomotic urethroplasty are high despite the fact that the majority have already failed multiple procedures including dilations, visual internal urethrotomy or prior urethroplasty. Preliminary cost effectiveness reports support the use of a single visual internal urethrotomy in a select patient population.